Friday, February 12, 2010

As I sat down at my computer station to finish the chart on a patient I had just treated, I heard something quite interesting. A voice, smooth and mellow, was calling out.

"Yoo-hoo."

It was an older woman's voice. I was immediately taken back to when I was a child, in my grandparent's house, standing beneath a small, cottage-shaped clock that hung on the wall. With a new hour approaching, I held my breath, staring up at the clock, its small pendulum swinging beneath, clicking a constant, relaxed beat. Eventually, the clock chimed, a little trap door opened, and a small bird popped out and chirped it's greeting.

"Coo-coo. Coo-coo. Coo-coo." Three times, like clock-work (no pun intended). Standing outside of my memory looking-in, I saw the little boy in his summer shorts, his tanned face framed with shaggy brown hair, smiling as he looked up expectantly at the wooden bird that never failed to mark a new hour.

"Yoo-hoo. Yoo-hoo." The woman's voice snapped me back to the present.

I got up from my chair and followed the yoo-hooing until I was standing at the bedside of an elderly woman with matted soft-grey hair and empty hazel eyes. She clearly had dementia. She looked quite comfortable, though, and was mumbling something to herself between the yoo-hoos.

"Do you need help with something, maam?" I asked, straightening her sheets and tucking her in. "What can I get you?"

"Help me!" the patient screamed, "I need help."

This patient's nurse walked in just then, a younger nurse that I enjoyed working with. She was compassionate, knowledgeable, and hard-working. And apparently, at that moment, frustrated.

"Is everything all right in here, Victoria?" I asked, ready to help.

"Everything's fine. Mrs. Pello has Alzheimer's and was sent by the nursing home because the nurse there thought she was acting 'more demented' today." Victoria gave me a knowing glance. We both recognized the bullshit excuse by the nurse who sent in Mrs. Pello, trying to make her own shift easier. At our expense, of course.

"Anything wrong?" I asked. "You need me to see her?"

"Dr. P. picked up on her. We're just going to get some baseline tests and a CT scan of her head. If it's all good, she'll be heading back soon enough."

"Yoo-hoo," Mrs. Pello called out, yet again.

"On second thought," Victoria said, laughing, "if you can get her to stop yelling 'yoo-hoo' every five minutes, I would appreciate it."

"I kind of like it," I said. "It reminds me of a coo-coo clock my grandparents had when I was a kid. She sounds just like the little bird that popped..."

I was interrupted by Mrs. Pello. "Help me! I need help!" Her sudden outburst had caught Victoria and I both by surprise. Then, without pausing, Mrs. Pello continued. "Yoo-hoo. Yoo-hoo."

"Just wait," Victoria warned me, both of us chuckling, "you might like it now, but after a few hours of this, I'm not so sure."

Well, little did I know at the time, but Victoria had hit the nail right on the head. Mrs. Pello's loud "yoo-hoo" was methodical and rhythmic, an audio alarm that was set to go off every five minutes, interrupting our workday. Unfortunately, her door had to be left open so that the nurses in their station could keep a close eye on her. And the risks of sedating her outweighed the benefits. So her yoo-hooing would just have to be accepted for a few hours.

Soon after meeting Mrs. Pello, a middle-aged man, who had collapsed at home, was brought into our ER and placed in the room next door. His right side was completely flaccid (no muscle strength) and he had a facial droop. An obvious stroke. A stroke alert was called and we emergently intubated this gentleman, hooked him up to a ventilator, and aggressively treated his escalating blood pressure. This patient was critical.

And then, suddenly, in the midst of treating this crisis, there it was. "Yoo-hoo. Yoo-hoo." It was clear and resounding. Everyone who was involved in treating our stroke patient did a quick pause. "Yoo-hoo." Mrs. Pello had added another one for good measure.

"Come on, people, back to work," I said, reminding them of our task at hand.

"What the hell was that?" the neurologist and neurosurgeon asked me, intrigued. "You really don't want to know," I said, grinning. My ER team, including Victoria, was shaking their heads, obviously trying to stifle their laughs. Swiftly, we transferred the stroke patient to the OR for emergent surgery after his CT scan revealed a large hemorrhagic stroke--blood on the brain.

Unfortunately, treating the stroke patient delayed Mrs. Pello's own head CT and she continued to sit in her room, waiting. "Yoo-hoo." Yep, about every five minutes.

At another point, as a family passed by Mrs. Pello's room while being escorted to their treatment room, she started screaming out "Help me! I need help." The family's eyes widened from fright. The staff, immune to the cries, didn't even budge to help, which I'm sure thoroughly impressed this family. They had to have thought of high-tailing it and heading to another ER. Someplace where the doctors and nurses cared.

Eventually, though, Mrs. Pello went over to the radiology department for her head CT. We all cheered, looking forward to a few minutes of silence. Unfortunately, not even five minutes had passed before we got an urgent call from the CT tech. "Can someone come over right away? Mrs. Pello is screaming for help." Oops, someone forgot to warn the tech of Mrs. Pello's outbursts.

She returned from her CT scan and, thankfully, all of her workup was normal. She had been in our emergency department for approximately four hours. Well, not approximately. More like exactly! Even those of us not involved in her care were celebrating her finished work-up and immediate plans to be transferred back to her nursing home. However, due to several ongoing emergencies, it would be one more hour of waiting until the ambulance service arrived to take her back. "Yoo-hoo."

Even though I wasn't treating her, I couldn't help but go into Mrs. Pello's room several more times to make sure she was comfortable. You see, not only did her "yoo-hoo" trigger a wonderful childhood memory of that coo-coo clock, but Mrs. Pello herself reminded me of my grandmother, an amazing and fiercely-independent woman who also was stricken with dementia.

Victoria was dead-on right. After five hours of "yoo-hoos," Mrs. Pello's voice had lost most of its charm and smooth, mellow tones. Now, her cries were simply annoying. Our staff gave her a wonderful farewell, lining up in the hallway to witness her be escorted by the ambulance team back to her nursing home. I think they were just making sure that there would be no screw-ups--that Mrs. Pello was actually leaving. Do not pass go. Do not collect $200. Just get the heck out!

Me? Well, of course, I was missing Mrs. Pello and her "yoo-hoos" five minutes after she was discharged. It was too quiet! And truth be told, I don't think I was alone. I think we all were suffering from yoo-hoo withdrawal.

So, I took a deep breath, calmed my fears, made my voice smooth and mellow, and did it.

"Yoo-hoo."

Update: One week later...Good news...you can hardly see my black-eye anymore. I just wish someone had warned me that Victoria knew karate!

As always, a big thanks for reading. The next post will be Monday, February 15. Happy Valentine's Day to all of you...

14 comments:

Another great story... unfortunately it recalled some not-so-great moments from my experience as a patient, where I wound up for a while with an old, perhaps demented roommate who was afflicted with that screaming problem. The wannabe physician in me wished I could help somehow; the exhausted patient part wanted nothing more than some peace and quiet (not easy to come by in the hospital, BTW!).

The funny part, though, was remembering my grandmother's German neighbor who had a genuine, fancy cuckoo clock that I always thought was kind of interesting. Fortunately neither of these nice ladies reached the state of your poor patient.

Year ago, while in nursing school, I worked in a long-term care facility as a care aid. We had a new resident who spent nearly 24hrs a day going, "Um?" like she was about to say something important, you know? On her first day, after about 5hrs of this, another resident (himself quite demented, but very mobile) walked right up to Mrs. Um, and punched her square in the face. In the end, we had to move Mrs. Um to a different floor, where most of the patients were bedridden, for her own safety.

Reminds me of another nursing home pt, in our ER for a # hip (lolfdgb!) who constantly screamed out "NURSE!" despite the morphine a loxapine on board. After several hours, she changed her tune, by screaming, "ALL THE NURSES ARE DEAD!" We howled with laughter!

I hope she has visitors where she lives. The thought that a nurse sent her to the ER for acting "more demented" is actually a sad commentary on the residential situations across the country for people like 'yoo hoo' and others that resemble the same 'dementia' characteristics.

Annoying as she was in the ER, she's probably parked in her nursing home completely alone.

In the OR, I would probably not hear long Yoo-hoo's except maybe by someone on the surgical team needing more supplies! :)

When I circulate, I get a little time with my patients during pre-op assessments. Once I had an 81 yo lady with dementia who was coming in for repair of a hip fracture. As I was trying to conduct my assessment, she kept screaming, "I know what you're up to! You work with THEM..." It was difficult to even check her ID because she thought I was going to kill her! That's when the anesthesiologist, who was amused by the whole scene, jumped in and pushed a little versed. Phew!

I couldn't sleep as an inpatient because of two demented patients once. Couple doors down ..every 3 seconds a lady screamed and every minute a man was hollering "Hello-o-o-o-o-?", from what seemed to be the lower outside corner of my room.

My friend's little 3 yr old daughter used to stand under our cuckoo clock ..waiting for the bird to pop out ..just like you did. She was so cute. :)

I love clocks ..which is funny because I am not good with time. But we have a grandfather clock, cuckoo and a small mantel clock that chimes and it's like they are part of the family. :)

I have childhood memories of the grandfather clock which is at least 80 years old this year. My mother remembers it coming into their house on a rainy, Saturday morning ..during the depression when she was 7 (1930). I've inherited it and it's still going strong ..but a bit off in the pitch of the gongs.

I still think of all the dementia patients in the nursing home where Mom had resided. She was newly diagnosed with alzheimers ..but I don't think she had that but rather a lot of mini strikes.

Anyway .. it is so upsetting to see people in this state. I always went along with whatever they said. Like one mom wheeled into mom's room ..offended because she said I was supposed to take her to the bank. I just said "Stephanie ..we're going to the bank in the morning" She said Oh and wheeled back out. I

It must be so hard to deal with those things all the time. And so very sad.

I always wondered what they did in their lives when they were younger.

When I think of demented patients, I always think of the ones that are screaming obscenities at their spouse. The children are stricken with embarrassment. You always hear, "This is not how my Mom (or Dad) used to be." The poor spouses don't seem to know what to do. Of course, neither do we. I have often wondered though if these vulgar names pointed towards the spouse are really pent up feelings that they held inside for years. I don't think older patients believe in divorce, stayed married for years and now all they really felt is making itself known. Probably not, I just thought it was a funny thought.

My family ran an adult foster home so I grew up around the elderly, many of whom where at least partially senile or suffering from one form of demensia or another. I miss all their quirks and various versions of 'yoo-hoo's we had over the years. One elderly lady I knew from volunteering at the local nursing home just sat in her chair all day and repeated 'help me honey, I can't help me, somebody help me'. The trick was to not let her grab hold of you, that little old lady had a steel grip that would leave bruises on your hand or arm she clung so tight. The halls seemed too quiet when she was sleeping, that near constand stream of 'help me honey, I can't help me, somebody help me' was as much a part of the place as the walls or ceiling. Its really sad to think of a nurse at a nursing home kicking a patient to the ER because they didn't want to listen to the sounds of advanced age! (although I can understand why it might be distracting in an ER to a doctor!)

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About Me

I am a father of three. I am an ER physician of 16 years. I am a son, a brother, an uncle, a cousin, a nephew, and a friend, always. I am an athlete. I am small-town. I live in a big town. I am from a large, forestry family. I miss my mother's voice. I enjoy life's simpler, mundane moments. I am humbled daily. I am privileged with many blessings in my life. I am a writer.

Disclaimer

The events and encounters described in this blog are for general discussion and amusement only. They should be considered fiction. Nothing written here should be constituted as medical advice. Although the events of this blog contain certain elemental truths, every attempt has been made to protect patient confidentiality. Names, dates, location, and identifying features have been changed or fictionalized for that reason. The author reserves the right to embellish to make a good story great. All opinions expressed herein are those of the author only. All content is copyright of the author. Please do not reproduce or copy in part or whole without his expressed permission.